That The Council for the International Promotion of Costa Rica Medicine, hereinafter PROMED, is a non-for-profit organization that gathers the interests of Costa Rica in positioning as international health tourism destination;

That PROMED promotes medical tourism under strict quality standards and patients safety, aware that the health of a person comes before any economical interest;

That PROMED considers the respect for the ethical principles in the medical profession as a priority in the development of any initiative related to health tourism;

That Organ Transplantation, one of the medical miracles of the XX century, has prolonged and improved the lives of hundreds of thousands of patients worldwide;

That this accomplishments have been tarnished by numerous reports denominated ¨Organ trafficking¨, defined in The Declaration of Istanbul as the recruitment, transport, transfer, harboring or receipt of living or deceased persons or their organs by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability, or of the giving to, or the receiving by, a third party of payments or benefits to achieve the transfer of control over the potential donor, for the purpose of exploitation by the removal of organs for transplantation.

That in 2004, the World Health Organization, called on member states "to take measures to protect the poorest and vulnerable groups from transplant tourism and the sale of tissues and organs, including attention to the wider problem of international trafficking in human tissues and organs"

That in order to address the urgent and growing problems of organ sales, transplant tourism and trafficking in organ donors in the context of the global shortage of organs, a Summit Meeting of more than 150 representatives of scientific and medical bodies from around the world, government officials, social scientists, and ethicists, was held in Istanbul from April 30 to May 2, 2008 and that allowed the approval of The Declaration of Istanbul on Organ Trafficking and Transplant Tourism.

The Association Council for the International Promotion of Costa Rica Medicine – PROMED, represented here by the members of its board of Directors,

DECLARES THAT THEY WILL

Support all necessary actions to increase deceased organ donation.

Promote initiatives that will tend to maximize the therapeutical potential of deceased organ donation.

Seek to share their information, experience and technology with those countries that look with effort to improve organ donation.

Promote, within the field of application, that the determination of the medical and psychosocial suitability of the living donor should be guided by the recommendations of the Amsterdam and Vancouver Forums (2-4). Particularly, will promote the incorporation of mechanisms for informed consent that should incorporate provisions for evaluating the donor’s understanding, including assessment of the psychological impact of the process, and will commit to ensure that all donors should undergo psychosocial evaluation by mental health professionals during screening.

Attempt that within the conditions for private health centers not to authorize transplants in their facilities, the origin of the patients of countries that have State and/or private programs that cover those treatments will be introduced, whereupon will no longer exist an objective reason that will justify the act of traveling in order to have performed a paid process in another country. The foregoing with the exception of the patients family residing in Costa Rica and that the donor is related to the recipient. Cases of patients from countries in process of development which transplant programs do not exist or are incipient will also be justified; as long as they fulfill all the related donor studies.

Seek that the provision of care includes medical and psychosocial care at the time of donation and for any short- and long-term consequences related to organ donation

Recognize that the adequate reimbursement of the actual, documented costs of donating an organ does not constitute a payment for an organ, but is rather part of the legitimate costs of treating the recipient. Such cost-reimbursement would usually be made by the party responsible for the costs of treating the transplant recipient. Relevant costs and expenses should be calculated and administered using transparent methodology, consistent with national norms. Reimbursement of approved costs should be made directly to the party supplying the service (such as to the hospital that provided the donor’s medical care). Reimbursement of the donor’s lost income and out-of-pockets expenses should be administered by the agency handling the transplant rather than paid directly from the recipient to the donor.

Recognize that the legitimate expenses that may be reimbursed when documented include: the cost of any medical and psychological evaluations of potential living donors who are excluded from donation (e.g., because of medical or immunologic issues discovered during the evaluation process); costs incurred in arranging and effecting the pre-, peri- and post-operative phases of the donation process (e.g., long-distance telephone calls, travel, accommodation and subsistence expenses); medical expenses incurred for post-discharge care of the donor and lost income in relation to donation (consistent with national norms).